Paxlovid may reduce long-term covid risk in some patients, VA study finds

“This study is very important. It has very important public health implications today.”

Even if a vaccine reduces the risk of hospitalization and death from SARS-CoV-2 infection, researchers continue to worry about the long-term individual suffering and threat to populations from covid.

Data released this summer by the Centers for Disease Control and Prevention household pulse survey suggests that nearly 15% of adults have been infected with COVID-19 for a long time, developing symptoms lasting more than three months after contracting the virus. The CDC recently enhanced a web-based survey to assess how these symptoms impact a long-haul passenger’s ability to carry out daily activities.

Ziyad Al-Aly, director of research and development for the VA St. Louis Health Care System and lead author of the new report, said it showed the importance of introducing antiviral drugs to reduce the severity of acute illness. It also lends credence to the idea that prolonged covid symptoms may be caused, at least in part, by the persistence of the virus, which is not fully cleared by infected individuals.

Al-Aly, a clinical epidemiologist at Washington University in St. Louis, said:

This new VA-funded study has been published online as a preprint. Publishing preprints has become more common in the climate of pandemic urgency, often leading to a form of near-instantaneous online peer review. Several prominent virologists have quickly and aggressively spoken out online.

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Eric Topol, professor of molecular medicine and executive vice president of Scripps Research, tweeted that the report is a “major step forward.” examination Findings from an online post highlighting the urgency to develop treatments for what is now widely recognized as a mass disorder.

“There are no validated therapies to treat long Covid,” Topol wrote. “Rigid, randomized, definitive clinical trials have been long overdue.”

As part of the National Institutes of Health’s $1.15 billion, there are plans to measure the effects of Pfizer’s drugs (nilmatrelvir and ritonavir) next year. recover The program, the agency recently announced. The clinical trial will enroll 1,700 adults. Results are not expected until 2024.

Some researchers said it would be useful to have access to data from Pfizer’s placebo-controlled clinical trial evaluating the impact of antiviral drugs on acute covid in thousands of volunteers.

David Putrino, Director of Rehabilitation Innovation, Mount Sinai Health System, New York, said:

Pfizer said the company is “collaborating with multiple agencies to initiate studies to evaluate Paxlovid for potential uses to combat covid in the long term.” In its 2022 financial guidance, the company reported Paxlovid earnings at $22 billion.

Clinicians have been largely hampered from developing specific treatments for long-term covid because the mechanisms, or mechanisms, behind the vast variety of reported symptoms have not been identified. Theories include viral persistence, microclot development, and acute inflammation, which other studies have shown can cause long-term damage.

Iwasaki notes that using paxlobid to block viral replication may prevent viral persistence as well as other mechanisms by confining the virus within the upper respiratory tract before it travels to other organs. I’m assuming there is.

“The virus is the trigger for all the other hypotheses,” Iwasaki said. “Pluck the buds as soon as possible so you can prevent some of these things.” She believes there are benefits to taking paxlovid as soon as possible after diagnosis.

New research has inherent limitations.

A registered person is entitled to receive the medicine. emergency use authorization It was issued by the Food and Drug Administration last year and is intended for anyone over the age of 12 who is at risk of serious illness, including those over the age of 65. As a result, the study did not include previously healthy young people, according to Benjamin Abramoff, director of Penn Medicine’s Post-COVID Assessment and Recovery Clinic.

There are no data to show whether these previously healthy young people will enjoy the same benefits as those at risk of serious illness. Putrino said the study’s encouraging results show the severity of acute illnesses that can lead to long-lasting complications, such as pulmonary fibrosis from pneumonia, pericarditis from inflammation, and what’s known as post-ICU syndrome. warned that it may be related to the ability of antivirals to mitigate. common symptoms.

Referring to chronic fatigue syndrome, Putrino said, “Many patients with prolonged COVID-19 had mild/non-hospitalized acute illness, but had debilitating, syndromic ME/CFS. He continued to develop a type of novel coronavirus infection.”

Because it is a retrospective study rather than a randomized controlled trial, it is possible that there are underlying differences between patients taking paxlobid and controls, including their involvement with physicians, that are not accounted for in this study. Yes, Abramoff said.

“This study provides more evidence for the importance of prospective, controlled studies to investigate paxlovid as a means of long-term covid prevention in the broader population,” Abramov said.

Lead author Al-Aly said the study also highlighted a significant underutilization of effective treatments, with 85% of those eligible to be prescribed antivirals taking it. I said I wasn’t taking it. “Is it because they weren’t offered it, or were there concerns?” he asked.

Some time after the study was published online, Al-Aly said he saw the general reader drawing erroneous conclusions.

“We are not saying that everyone should take paxlovid,” Al-Ali said. “At the moment, we don’t know that. People have to figure it out.”